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Eating-out behaviors, associated factors and associations with obesity in Chinese school children: findings from the childhood obesity study in China mega-cities

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Abstract

Purpose

Eating-out and prevalence of obesity/overweight have been rising rapidly in China in the past two decades due to social economic developments. This study examined Chinese school children’s eating-out behaviors and associated factors, including their association with obesity during a 3-year follow.

Methods

Data were collected from 3313 primary and middle school children aged 7–16 years in five mega-cites across China in 2015, 2016 and 2017, in an open cohort study. Eating-out behaviors were assessed using questionnaire survey. The Chinese age-sex-specific body mass index (BMI) cutoffs were used defining child overweight/obesity (combined) and obesity; central obesity was defined as WHtR ≥ 0.48. Mixed effect models examined associations between child eating-out behaviors and BMI, overweight and obesity in this longitudinal data, adjusting for other covariates.

Results

About 80.1% of the children reported having eaten out ≥ 1 times/week over the past 3 months; 46.7% and 70.9% chose Western- and Chinese-style food when ate out, respectively. Meanwhile, 29.8% of them were overweight/obese, 12.7% were obese and 20.1% had central obesity. Child eating-out behaviors were positively associated with parents’ eating-out behaviors (p < 0.05). Boys were more likely to choose Western-style food than girls (OR 1.27; 95% CI 1.09–1.48) when eating out. Compared to non-overweight/obese children, those being overweight/obese at baseline were less likely to eat out dining on Western-style food during the follow-up.

Conclusion

Eating-out is common among school children in major cities in China, but with considerable differences across groups. Children’s weight status was associated with eating-out behaviors.

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Availability of data and materials

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

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Acknowledgements

We thank all of the study participants and the school personnel who participated in the study. We also thank those worked in the data collection and our collaborators from multiple institutes in China and the USA who have contributed to this study.

Funding

This study was funded in part by research grants from the National Institute of Health (NIH, U54 HD070725) and the United Nations Children's Fund (UNICEF2018-Nutrition-2.1.2.3).

Author information

Authors and Affiliations

  1. Global Health Institute, Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China

    Jinge Zheng, Liwang Gao, Junxiang Wei & Youfa Wang

  2. Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA

    Hong Xue

  3. Shannxi Center for Disease Control and Prevention, Xi’an, Shannxi, People’s Republic of China

    Bo Xue

  4. Department of Health Policy and Management, West China School of Public Health, Sichuan University, Chengdu, Sichuan, People’s Republic of China

    Li Zhao

  5. National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China

    Yun Wang

  6. Department of Obstetrics, Northwest Women and Children’s Hospital, Xi’an, People’s Republic of China

    Junxiang Wei

  7. Department of Nutrition and Health Science, Fisher Institute of Health and Well-Being, College of Health, Ball State University, Muncie, IN, People’s Republic of China

    Youfa Wang

Authors
  1. Jinge Zheng
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  2. Liwang Gao
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  3. Hong Xue
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  4. Bo Xue
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  5. Li Zhao
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  6. Yun Wang
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  7. Junxiang Wei
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Contributions

YW and JW conceived and designed the study. JZ, BX, LG, LZ and YW collected the data. JW, HX and YW analyzed the data and interpreted the results. JW prepared the manuscript, and YW, HX and LZ helped revised the manuscript. All authors reviewed and approved the final manuscript.

Corresponding authors

Correspondence to Junxiang Wei or Youfa Wang.

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Conflict of interest

The authors declare that they have no competing interests.

Ethics approval and consent to participate

This study was approved by Ethical Committee of the State University of New York at Buffalo (FWA00008824) and related collaborative institutes in China. Written informed consents were collected from school administrators and parents and/or children.

Consent for publication

Written informed consents for publication were collected from parents and/or children.

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Zheng, J., Gao, L., Xue, H. et al. Eating-out behaviors, associated factors and associations with obesity in Chinese school children: findings from the childhood obesity study in China mega-cities. Eur J Nutr 60, 3003–3012 (2021). https://doi.org/10.1007/s00394-020-02475-y

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  • DOI: https://doi.org/10.1007/s00394-020-02475-y

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